scholarly journals Comparing role of laparoscopy, ultrasound and clinical examination in pelvic pain

2017 ◽  
Vol 6 (7) ◽  
pp. 2983
Author(s):  
Hema Bharwani ◽  
Meena Jain
Keyword(s):  
Sensitivity And Specificity ◽  
Clinical Examination ◽  
Pelvic Pain ◽  
Diagnostic Error ◽  
Reproductive Age ◽  
Age Group ◽  
History Of ◽  
Common Sign ◽  
One Year ◽  
The One

Background: Pelvic pain is a frequent and poorly understood complaint in women of reproductive age group, which is one of the most perplexing problems faced by the gynaecologist. This study was conducted to detect the cause of pelvic pain and to correlate clinical diagnosis, ultrasound, and laparoscopic di-agnosis and formulate treatment modalities.Methods: This study was conducted in the Department of Obstetrics and Gynecology, JLN Hospital and RC, Bhilai, Chattisgarh during the one year period from September 2014 to August 2015. 97 women belonging age 15 to 65 years with history of pelvic pain (acute / chronic) were admitted after excluding history of acute abdominal trauma, diagnosed gynaecological malignant disorder, severe cardiac/respiratory disease or signs of peritonitis. A detailed history was taken and clinical examination was done.Results: The age group in the present study was between 15 to 65 years. Among them, 36% cases belonged to 20-30 years age group. Clinically the most common sign was abdominal tenderness (59.89%). Clinically 47 cases (48.45%) had abnormal findings, on ultrasonography 61 cases (62.88%) had abnormal findings as compared to laparoscopy which could detect 75 cases (77.32%) showing abnormality. Most common pelvic pathology was adhesions (17.52%) followed by PID (14.43%). None of the cases of adhesions, fimbrial cyst, pelvic congestion syndrome and appendicitis were diagnosed clinically or ultrasonographically, all cases were diagnosed on laparoscopy. The sensitivity and specificity of clinical examination is 54% and 49% as compared to laparoscopy respectively. The PPV and NPV of clinical examination is 24% and 78% respectively. The sensitivity and specificity of ultrasonography is 59% and 69% as compared to laparoscopy respectively. The PPV and NPV of Ultrasonography is 36% and 85% respectively. Appropriate surgical intervention like salphingooopherectomy, adhesiolysis, myomectomy, hysterectomy was carried out laparoscopically.Conclusions: Laparoscopy eliminates the diagnostic error and corrects the wrong diagnosis. Laparoscopy is a more sensitive and superior method for evaluation of pelvic pain as compared to Ultrasonography. Laparoscope has definitive place in evaluating patients with pelvic pain and often a definitive procedure can be undertaken with the laparoscope without subjecting the patient to laparotomy.

scholarly journals Evaluation of the Diagnostic Accuracy of the Interview and Physical Examination in the Diagnosis of Endometriosis as the Cause of Chronic Pelvic Pain

2021 ◽  
Vol 18 (12) ◽  
pp. 6606
Author(s):  
Jolanta Nawrocka-Rutkowska ◽  
Iwona Szydłowska ◽  
Aleksandra Rył ◽  
Sylwester Ciećwież ◽  
Magdalena Ptak ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Pelvic Pain ◽  
Predictive Value ◽  
Chronic Pelvic Pain ◽  
Reproductive Age ◽  
Pelvic Surgery ◽  
History Of Surgery ◽  
Previous Surgery ◽  
History Of

Background: Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20–40%). Despite CPP being the main symptom of endometriosis, the disease is confirmed by laparoscopy only in 12–18% of cases. The aim of this study was to evaluate the results of laparoscopy in women with CCP and to assess the sensitivity and specificity of elements of an interview and clinical examination. Materials and methods: The study included 148 women with CPP. Each patient underwent laparoscopy. In laparoscopy, the presence of endometriosis and/or peritoneal adhesions was confirmed. Then, the sensitivity and specificity and the positive and negative predictive value of endometriosis symptoms or abnormalities in the gynecological examination were statistically calculated. Results: After previous surgery, adhesions were found in almost half (47%) of patients. In patients without a history of surgery, adhesions were diagnosed in 6.34% of patients. Endometriosis without coexisting adhesions was more often diagnosed in women without previous surgery (34.9%), compared to 10.58% in the group with a history of surgery (p < 0.05). Conclusions: Intraperitoneal adhesions are most common in women after pelvic surgery and with chronic ailments. The best results for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of endometriosis are found in women with irregular menstruations during which the pain increases. Laparoscopy still remains the primary diagnostic and therapeutic method for these women.

Clinical and anamnestic characteristics of patients with adenomyosis, accompanied by pelvic pain syndrome

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 77-80
Author(s):  
M R Orazov ◽  
V E Radzinsky ◽  
M B Khamoshina ◽  
A O Dukhin ◽  
L R Toktar ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Reproductive Age ◽  
Pelvic Pain Syndrome ◽  
Common Disease ◽  
Contributing Factors ◽  
High Prevalence ◽  
Inflammatory Processes ◽  
History Of

Pelvic pain syndrome associated with adenomyosis is a common disease in women of reproductive age. Frequency of detection in the population varies from 10 to 53%. The aim - to study the clinical and anamnestic risk factors of pelvic pain, with adenomiose. Materials and methods. The study included 120 (n=120) patients with diffuse adenomyosis with pain and painless form of the disease who underwent examination and treatment in the gynecological Department of the Central clinical hospital №6 of Russian Railways in Moscow. Each patient was provided with an individual card, which was encrypted 171 sign. The studied parameters reflected the passport and anthropometric data, information about education, social status, presence of occupational hazards, complaints, illness. Results. Burdened gynecological and somatic histories, manifested a low health index, a more pronounced hereditary a family history of neoplastic diseases are contributing factors, and high prevalence of postponed surgeries, chronic, long-term ongoing inflammatory processes of the pelvic organs to create a favorable background for the further progression of chronic pelvic pain syndrome in adenomiose.

scholarly journals Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

2021 ◽  
Author(s):  
Shinwan Kany ◽  
Johannes Brachmann ◽  
Thorsten Lewalter ◽  
Ibrahim Akin ◽  
Horst Sievert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial Appendage ◽  
Systemic Embolism ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
The One

Abstract Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract

scholarly journals An epidemiological study of the prevalence and determinants of overweight and obesity in women of reproductive age (15 to 49 years) group in an urban slum

2021 ◽  
Vol 8 (5) ◽  
pp. 2460
Author(s):  
Pratibha U. Mulik ◽  
Sudam R. Suryawanshi
Keyword(s):  
Public Health ◽  
Physical Exercise ◽  
Significant Relationship ◽  
Public Health Problem ◽  
Urban Slum ◽  
Overweight And Obesity ◽  
Reproductive Age ◽  
Health Concern ◽  
Age Group ◽  
History Of

Background: After comparing data of NFHS-3 and 4, prevalence of overweight and obesity in women of an urban population almost doubled in 10 yr. So, the causes of increasing prevalence need to be studied as public health concern. Objective of the study is to determine prevalence of overweight and obesity among reproductive age group (15-49 years) of women in an urban slum of Mumbai.Methods: Total 220 women were selected among 11 sectors from A to K by simple random method and data collected by using validated questionnaire. WHO’s classification was used to classify as overweight and obese.Results: Out of 220 women participated in study, 14 (6.36%) were obese, 75 (34.09%) were overweight according to BMI and 17 (7.7%) were found to be obese according to waist to hip ratio. From the present study it was seen that age group of the women, socio economic class, education, history of hypothyroidism, family history of obesity, types of work women do, hours of television watching, calorie and fat intake, had a significant relationship with BMI, whereas physical exercise they used to do and tendency to sleep in the afternoon and hours of sleep in the night had non-significant relationship with BMI.Conclusions: Obesity and overweight is found to be a growing public health problem and can be preventable. Interventional measures include developing healthy eating habits, regular moderate physical exercise, sleeping habits, health camps for screening of overweight and obesity.

scholarly journals Psychiatric Illnesses among the Patients Admitted for Self-poisoning in a Tertiary Care Hospital of Nepal

2013 ◽  
Vol 2 (1) ◽  
pp. 10-13 ◽  
Author(s):  
Ajay Risal ◽  
Pushpa Prasad Sharma ◽  
Rajkumar Karki
Keyword(s):  
Tertiary Care Hospital ◽  
Organophosphorus Compounds ◽  
Care Center ◽  
Tertiary Care ◽  
Psychiatric Evaluation ◽  
Care Hospital ◽  
Age Group ◽  
Psychiatric Illnesses ◽  
History Of ◽  
One Year

Background and Aims- Self-poisoning is the commonest mode of suicide in our part of the world. Patients attempting suicide by self-poisoning usually land up in the Emergency. They are admitted for management of medical complications and subsequently referred to Psychiatry for evaluation of possible Psychiatric illnesses. The aim of this study was to explore the patterns of psychiatric illnesses in the patients admitted for self-poisoning in a tertiary care center in Nepal. Methods- The study population included those patients who were admitted and being managed for self-poisoning and brought for psychiatric evaluation during the period of one year (1st June 2011- 30th June 2012) at Dhulikhel Hospital, Nepal. Each patient underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Details including sociodemographic data, psychiatric diagnosis, and treatment offered and outcome was tabulated and analyzed using SPSS-16. Results- Among the total patients (N=100), 43 were in the age group 21-40 years, median age being 27.5. There was almost equal gender distribution. Majority was of Mongolian ethnicity, homemaker by occupation and married. More than 90% were single-attempters, suicidal attempt using organophosphorus compounds. Almost 50% had depression; family dispute (19%) and marital disharmony (17%) were the most common psychosocial precipitant. Conclusion- Patients with history of self-poisoning are commonly brought to the Emergency Department of any tertiary care hospital. It is widely prevalent on younger age group. It is usually by the use of Organophosphorus compound in our setting and most commonly associated with depression. Hence, psychiatric care is essential for these patients. Journal of Advances in Internal Medicine 2013;02(01):10-13 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7630

ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group

2016 ◽  
Vol 32 (2) ◽  
pp. 108-115 ◽  
Author(s):  
Priyadarshani R. Bhosale ◽  
Marcia C. Javitt ◽  
Mostafa Atri ◽  
Robert D. Harris ◽  
Stella K. Kang ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Reproductive Age ◽  
Age Group ◽  
Appropriateness Criteria ◽  
Acr Appropriateness Criteria ◽  
Acute Pelvic Pain ◽  
Reproductive Age Group

CONSANGUINITY AND MATERNAL AGE;

2017 ◽  
Vol 24 (04) ◽  
pp. 511-515
Author(s):  
Nayyab Zehra ◽  
Ahmed Hassaan Malik ◽  
Zahabia Khalid ◽  
Misha Sabir ◽  
Simra Tanvir ◽  
...  
Keyword(s):  
Family History ◽  
Gestational Age ◽  
Maternal Age ◽  
Sampling Technique ◽  
Reproductive Age ◽  
Military Hospital ◽  
Age Group ◽  
Spontaneous Abortions ◽  
Cross Sectional ◽  
History Of

Objectives: To determine the frequency of risk factors i.e. consanguinity andmaternal age associated with spontaneous abortions in Pakistan and to propose ways toreduce them. Study design: Cross sectional descriptive study. Place of study: Gynecologydepartment of Military Hospital and Combined Military Hospital, Rawalpindi. Duration ofstudy: 6 months (September 2015 to February 2016). Sampling technique: Non probabilityconvenient sampling. Methodology: 150 married female patients in reproductive age group(15-49 years), who were confirmed cases of pregnancy and presented with abortions, wereinterviewed and responses were filled in a structured questionnaire after written consent.The collected data was then entered and analyzed by SPSS 20.0. Results: The major bulkof spontaneous abortions occurred in the maternal age group of 25-35 years (55.3%). A totalof 53.3% of abortions occurred in the gestational age of less than 12 weeks. Around 54.7% offemales had family history of spontaneous abortions and 65.3% had consanguineous marriage.Conclusion: Spontaneous abortions occur more frequently in the females of 25-35 yearsage group and among the fetuses with gestational age less than 12 weeks (1st trimester ofpregnancy). Family history of spontaneous abortions and consanguinity are associated withspontaneous abortions.

scholarly journals Adnexal mass: a clinicopathological study at a tertiary care centre in Assam, India

2019 ◽  
Vol 8 (4) ◽  
pp. 1457
Author(s):  
Mukut Jyoti Das ◽  
Pranay Phukan
Keyword(s):  
Clinical Examination ◽  
Adnexal Mass ◽  
Histopathological Examination ◽  
Color Doppler ◽  
Tertiary Care ◽  
Broad Ligament ◽  
Reproductive Age ◽  
Transvaginal Sonography ◽  
Age Group ◽  
Adnexal Masses

Background: An adnexal mass may be found in females of all ages with significantly variable prevalence, but more common among women of reproductive age. Adnexal masses pose a special dilemma to the attending gynaecologist because the diagnosis is often difficult and differential diagnosis is vast. Clinical examination is the first step in evaluation of patients with adnexal mass. Pelvic masses which are undetected or overlooked on physical examination can be identified by Ultrasonography. The aims and objectives of the study were to: to find out different types of adnexal pathology clinically, correlation of clinical finding with histopathology, correlation of ultrasonography finding with histopathology.Methods: The present study was carried in the Department of Obstetrics and Gynecology, Assam medical college and hospital, Dibrugarh from 1st July 2017 to 30th June 2018. This study was a hospital based observational study which included 145 patients of adnexal mass attending the GOPD who required admission and operative intervention. All cases underwent an abdominal ultrasound examination with color Doppler. Transvaginal sonography was done wherever feasible. Following surgery, specimens were sent for histopathological examination and the reports were correlated with pre-operative clinical and ultrasonography findings.Results: The most common site of origin of adnexal mass was ovary (92.41%) followed by fallopian tube (6.20%) and broad ligament (1.39%). Majority (79.31%) were non neoplastic or benign adnexal masses. All cases of adnexal malignancy were of ovarian origin. The sensitivity and specificity of clinical examination for diagnosis and discriminating benign and malignant ovarian neoplasms were 70% and 86.6% and that of ultrasonography was 86.67% and 96.65% respectively.Conclusions: Adnexal mass in reproductive age group were mostly non neoplastic and benign, whereas malignancy was mostly seen in peri and post-menopausal age group. Ultrasonography is a useful adjunct to clinical examination for diagnosis and proper management of patients with adnexal mass in low resource setup.

scholarly journals CHC for pelvic pain in women with endometriosis: ineffectiveness or discontinuation due to side-effects

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Paul J Yong ◽  
Najla Alsowayan ◽  
Heather Noga ◽  
Christina Williams ◽  
Catherine Allaire ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Health Research ◽  
Reproductive Age ◽  
Surgical Data ◽  
History Of ◽  
Pelvic Floor Myalgia

Abstract STUDY QUESTION What are the use patterns and factors associated with combined hormonal contraception (CHC) ineffectiveness or discontinuation due to side-effects in patients with endometriosis and pelvic pain? SUMMARY ANSWER Worse chronic pelvic pain (CPP) severity and pelvic floor myalgia were associated with continuous CHC ineffectiveness, while poorer quality-of-life was associated with continuous CHC discontinuation due to side-effects. WHAT IS KNOWN ALREADY CHC is a first line of therapy for endometriosis-associated pelvic pain in women. However, some patients state that CHC is ineffective for their pain, while others have to discontinue CHC due to side-effects. STUDY DESIGN, SIZE, DURATION Analysis of a prospective patient database from a tertiary care referral center for patients with endometriosis and pelvic pain between December 2013 and April 2015 was carried out. PARTICIPANTS/MATERIALS, SETTING AND METHODS A total of 373 patients of reproductive age with endometriosis from the database were included in the study. Data included patient self-reported questionnaires, physical examination findings and validated instruments. There were four variables of interest: history of cyclical CHC ineffectiveness (yes/no), history of cyclical CHC discontinuation due to side-effects (yes/no), history of continuous CHC ineffectiveness (yes/no) and history of continuous CHC discontinuation due to side-effects (yes/no). The primary outcome was CPP severity for the past 3 months (score of 0–10), and secondary outcomes were other pelvic pain scores, quality-of-life on the Endometriosis Health Profile 30 (EHP-30) and underlying conditions including irritable bowel syndrome, painful bladder syndrome, abdominal wall pain, pelvic floor myalgia and depression, anxiety and pain catastrophizing. MAIN RESULTS AND THE ROLE OF CHANCE Among the 373 cases in the dataset, prior cyclical CHC use was reported by 228 (61.1%) women, of which 103 (27.6%) stated it was ineffective for their pain and 94 (25.2%) stated they discontinued CHC due to side-effects. Previous continuous CHC use was reported by 175 (46.9%) women, of which 67 (18.0%) stated it was ineffective and 59 (15.8%) stated they discontinued due to side-effects. Worse CPP severity in the last 3 months was associated with a history of continuous CHC ineffectiveness (P &lt; 0.001). Poorer quality-of-life was present in women who reported a history of continuous CHC discontinuation due to side-effects (P = 0.005). Among the underlying conditions, pelvic floor tenderness (as a marker of pelvic floor myalgia) was associated with CHC ineffectiveness. LIMITATIONS AND REASONS FOR CAUTION This study involved patient recall and no longitudinal follow-up. Also, we do not have data on the type of side-effect that led to discontinuation. Medication ineffectiveness was reported subjectively by the patient rather than using standardized criteria. Finally, the diagnosis of endometriosis was based on previous surgery or a current nodule or endometrioma on examination/ultrasound; without prospective surgical data on all the patients, it was not possible to do a sub-analysis by current surgical features (e.g. stage). WIDER IMPLICATIONS OF THE FINDINGS In women with endometriosis, CHC ineffectiveness was associated with worse CPP and pelvic floor myalgia, which suggests myofascial or nervous system contributors to CPP that does not respond to hormonal suppression. A tender pelvic floor, as a sign of pelvic floor myalgia, may be a clinical marker of patients with endometriosis who are less likely to have an optimal response to hormonal suppression. For women who discontinue CHC due to side-effects, research is needed to help alleviate these side-effects as these patients report worse quality-of-life. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a Canadian Institutes of Health Research (CIHR) Transitional Open Operating Grant (MOP-142273) as well as BC Women’s Hospital and the Women’s Health Research Institute. PY is also supported by a Health Professional Investigator Award from the Michael Smith Foundation for Health Research. MB/CA has financial affiliations with Abbvie and Allergan; the other authors have no conflicts of interest.

scholarly journals Adolescent endometriosis

2017 ◽  
Vol 6 (8) ◽  
pp. 3213
Author(s):  
Meenu P. Nanthakumar ◽  
Sendhil C. Arumugam
Keyword(s):  
Adverse Effects ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Reproductive Age ◽  
Age Group ◽  
Women Of Reproductive Age ◽  
Surgical Options ◽  
Reproductive Age Group

Endometriosis is predominantly a disease of women of reproductive age group. Endometriosis is not uncommon in adolescents. Presentation tends to focus on pain, especially intractable dysmenorrhea and chronic pelvic pain. In around 60% of patients with endometriosis symptoms start in adolscence. Pain unresponsive to treatment is the usual indication for a Laproscopy. The appearance of endometriotic lesions is different from that of adults. Medical and surgical options for treatment are available. Endometriosis may be progressive and adverse effects may go beyond pain and cause infertility.

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